This invention relates to assistive communication devices, and particularly to computer-based devices which allow individuals with a temporary or permanent speech impairment to communicate by constructing messages which are output using speech synthesizers, on-screen and remote text display, as well as telephone and e-mail interfaces. More particularly, this invention relates to such devices that can be used by a patient in an acute-care or other healthcare or home setting with little or no instruction from any other person.
Patients in intensive care units in hospitals as well as a significant number of patients in other health-care settings often find themselves temporarily unable to speak and therefore unable to communicate their medical and emotional needs to health care providers or family members. The reasons for the inability to speak are varied, but include stroke, spinal cord injury, head injury, cancer, other degenerative diseases, and intubation associated with mechanical ventilation.
A number of different methods are typically employed to help hospital patients attempt to communicate with medical staff and family members. The most commonly used methods are lip reading, use of alphabet or word boards, handwriting, and gesturing.
General weakness and loss of muscle tone which frequently occur in patients on ventilator support often makes handwriting difficult to interpret. In addition, ventilated patients are frequently restrained (to prevent accidental extubation), further complicating any attempts to communicate via handwriting.
The remainder of the techniques mentioned above (alphabet/word boards, lip reading, and gesturing) are often very tedious, and may require the participation of a trained “communication partner.” Even with experience in the use of these alternative communication methods, nurses state that they often leave the room having no idea what the patient was trying to communicate.
Complicating the situation is the fact that ventilated patients not infrequently experience compromised vision, making visually-based methods difficult for these patients. Nursing shortages and demands on nurses' time make it hard for nurses to devote large amounts of time to communication efforts, so that even when these alternative methods are successful, they typically restrict the patient to communicating basic nursing needs rather than more complex concerns, emotions, or feelings.
Another issue related to patient care is the fact that patients who cannot communicate with the nurses' station using the normal method (call button/intercom combination) are at a serious disadvantage in having their medical and emotional needs met. This inability of speech impaired patients to communicate with the nurses' station also affects the efficiency of the nursing operation, because the nurses' station personnel are unable to assess the reason why the patient pressed the call button, and are therefore hampered in their ability to prioritize their response to the call button event with respect to other patients' needs. Similarly, without knowledge of why the patient pressed the call button, the nurses' station staff are limited in their ability to send an appropriate staff member (e.g., a nurse as opposed to a nurse's aide) to the room, therefore resulting in inefficient use of nursing resources.
The inability of ventilated patients to speak, coupled with the handwriting difficulties mentioned above, results in situations in which proper, complete medical histories are sometimes not obtained from seriously ill patients who enter the hospital suddenly and shortly afterward are put on ventilator support. Because this type of communication difficulty may result in patients not being able to adequately describe previous illnesses, on-going medication needs, and drug allergies, the speech-impaired patient may be at a significantly higher risk for in-hospital complications than his or her speech-capable counterparts.
Patients whose illness or injuries require longer term, in-hospital ventilator support often elicit the help of nursing staff with lip reading expertise to place, or respond to, telephone calls to, or from, family members who are unable to visit the hospital on a regular basis. Nurses who become involved in this “interpretive” role often comment about the tremendous amount of time it takes away from other nursing activities, as well as the fact that they are placed in a very awkward position which prevents the patient from having a confidential conversation without a stranger present.
A variety of assistive communication devices (sometimes referred to as augmentative and alternative communication—i.e., AAC—devices) are available for individuals with long term-medical disabilities (such as amyotrophic lateral sclerosis—i.e., ALS). These systems include touchscreen and switch-activated computers with integrated or add-on speech synthesizer functionality, which may be provided by hardware, software or a combination of both, and which is hereafter referred to as a speech engine. These devices are typically optimized for “face-to-face” verbal communication in a home, school, or work setting but lack key functionality required to fulfill the needs of short-term patients in a hospital or health-care setting. For example, they lack an integrated interface to allow communication to a hospital's nurses' station or to caregivers who are not in the patient's room, and do not address the short-term communication needs of permanently or temporarily visually impaired patients who also are at least temporarily speech-impaired, or the needs of patients who may be temporarily or permanently unable to comprehend written text. In addition, these devices typically require that a professional familiar with the device provide instruction in its use, thus limiting their potential use in a short-term acute-care setting where limited time and resources may exist for such instruction and training, and where a patient may not be in a condition requiring the device for a long enough period of time to justify the instructional effort.
Accordingly, there is a need for an integrated assistive communication system which requires minimal patient training, and which will allow an individual with a temporary speech impairment to easily communicate medical and emotional needs to health-care professionals and family members.